VAST: Vascular Flow Analysis and Segmentation for Intracranial 4D Flow MRI.

Four-dimensional (4D) Flow MRI can noninvasively measure cerebrovascular hemodynamics but remains underused clinically because current workflows rely on manual vessel segmentation and yield velocity fields sensitive to noise, artifacts, and phase aliasing. We present VAST (Vascular Flow Analysis and Segmentation), an automated, unsupervised pipeline for intracranial 4D Flow MRI that couples vessel segmentation with physics-informed velocity reconstruction. VAST derives vessel masks directly from complex 4D Flow data by iteratively fusing magnitude- and phase-based background statistics. It then reconstructs velocities via continuity-constrained phase unwrapping, outlier correction, and low-rank denoising to reduce noise and aliasing while promoting mass-consistent flow fields, with processing completing in minutes per case on a standard CPU. We validate VAST on synthetic data from an internal carotid artery aneurysm model across SNR = 2-20 and severe phase wrapping (up to five-fold), on in vitro Poiseuille flow, and on an in vivo internal carotid aneurysm dataset. In synthetic benchmarks, VAST maintains near quarter-voxel surface accuracy and reduces velocity root-mean-square error by up to fourfold under the most degraded conditions. In vitro, it segments the channel within approximately half a voxel of expert annotations and reduces velocity error by 39% (unwrapped) and 77% (aliased). In vivo, VAST closely matches expert time-of-flight masks and lowers divergence residuals by about 30%, indicating a more self-consistent intracranial flow field. By automating processing and enforcing basic flow physics, VAST helps move intracranial 4D Flow MRI toward routine quantitative use in cerebrovascular assessment.